title: Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial.
abstract: OBJECTIVE
  Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program.
  
  
  OBJECTIVE
  To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication.
  
  
  METHODS
  Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012.
  
  
  METHODS
  Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition.
  
  
  METHODS
  The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey.
  
  
  RESULTS
  Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P < .001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004).
  
  
  CONCLUSIONS
  A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00693940.
authors.affiliation: Northwestern University Feinberg School of Medicine Department of Medicine, Chicago, Illinois 60611, USA. mdm608@northwestern.edu
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Bonnie
authors.initials: B
authors.lastname: Spring
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Kathryn
authors.initials: K
authors.lastname: Domanchuk
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd-Jones
authors.forename: Melina
authors.initials: M
authors.lastname: Kibbe
authors.forename: Huimin
authors.initials: H
authors.lastname: Tao
authors.forename: Lihui
authors.initials: L
authors.lastname: Zhao
authors.forename: Yihua
authors.initials: Y
authors.lastname: Liao
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D015928:Cognitive Behavioral Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D058729:Peripheral Arterial Disease / Q000628:therapy*; D010807:Physical Endurance; D011615:Psychotherapy, Group; D012657:Self-Help Groups; D016896:Treatment Outcome; D016138:Walking